Beneficial effects of angiotensin-converting enzyme inhibitor and nitrate association on left ventricular remodeling in patients with large acute myocardial infarction: the Delapril Remodeling after Acute Myocardial Infarction (DRAMI) trial.

Roberto Latini, Lidia Staszewsky, Aldo P. Maggioni, Paolo Marino, Francisco Hernandez-Bernal, Gianni Tognoni, Violeta Labarta, Silvana Gramenzi, Federico Bianchi, Giuseppe Sarcina, Giovanni Cremonesi, Gian Luigi Nicolosi, Enrico Geraci

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: In the large-scale trial, Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-3 (GISSI-3), patients receiving the combination of lisinopril and glyceryl trinitrate benefited most from experimental therapy. Therefore, a multicenter, randomized, double-blind study, Delapril Remodeling After Acute Myocardial Infarction (DRAMI), was designed to assess (1) the possible additive beneficial effect on left ventricular remodeling of nitrates when combined with an angiotensin-converting enzyme inhibitor (ACEI), and (2) the tolerability of a new ACEI, delapril, in respect to lisinopril in patients with large myocardial infarction (MI). METHODS: A total of 177 patients were randomized to receive delapril plus isosorbide-5-mononitrate (IS5MN) placebo, delapril plus IS5MN, lisinopril plus IS5MN placebo, or lisinopril plus IS5MN starting within the first 36 hours after the onset of symptoms and continuing for 3 months. RESULTS: More than 80% of the patients showed extensive ST-segment changes and 36.7% had signs or symptoms of heart failure during the first 36 hours. Over 3 months, IS5MN reduced, by 76%, the increase in LVEDV (17.4 +/- 5.0 mL placebo vs 4.2 +/- 4.4 mL IS5MN, P =.0439), reversed the increase in LVESV (7.5 +/- 3.9 mL placebo vs -5.5 +/- 2.9 mL IS5MN, P =.0052), and increased the recovery of LVEF (1.9% +/- 1.3% placebo vs 6.7% +/- 1.2% IS5MN, P =.0119). Overall, 3-month mortality was 10.2%; the most frequent clinical events were new episodes of severe heart failure (18.1%), persistent hypotension (10.7%), and post-MI angina (18.1%), with no differences between treatment groups. CONCLUSIONS: Administration for 3 months of IS5MN combined with an ACEI, both started within 36 hours from the onset of symptoms, was safe and effective in reducing LV dilation and dysfunction after MI. The 2 ACEIs, delapril and lisinopril, appeared to be equally well tolerated.

Original languageEnglish
Pages (from-to)133
Number of pages1
JournalAmerican Heart Journal
Volume146
Issue number1
Publication statusPublished - Jul 2003

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isosorbide-5-mononitrate
Ventricular Remodeling
Angiotensin-Converting Enzyme Inhibitors
Nitrates
Lisinopril
Myocardial Infarction
Placebos
Heart Failure
delapril
Investigational Therapies
Nitroglycerin
Double-Blind Method

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Beneficial effects of angiotensin-converting enzyme inhibitor and nitrate association on left ventricular remodeling in patients with large acute myocardial infarction : the Delapril Remodeling after Acute Myocardial Infarction (DRAMI) trial. / Latini, Roberto; Staszewsky, Lidia; Maggioni, Aldo P.; Marino, Paolo; Hernandez-Bernal, Francisco; Tognoni, Gianni; Labarta, Violeta; Gramenzi, Silvana; Bianchi, Federico; Sarcina, Giuseppe; Cremonesi, Giovanni; Nicolosi, Gian Luigi; Geraci, Enrico.

In: American Heart Journal, Vol. 146, No. 1, 07.2003, p. 133.

Research output: Contribution to journalArticle

Latini, R, Staszewsky, L, Maggioni, AP, Marino, P, Hernandez-Bernal, F, Tognoni, G, Labarta, V, Gramenzi, S, Bianchi, F, Sarcina, G, Cremonesi, G, Nicolosi, GL & Geraci, E 2003, 'Beneficial effects of angiotensin-converting enzyme inhibitor and nitrate association on left ventricular remodeling in patients with large acute myocardial infarction: the Delapril Remodeling after Acute Myocardial Infarction (DRAMI) trial.', American Heart Journal, vol. 146, no. 1, pp. 133.
Latini, Roberto ; Staszewsky, Lidia ; Maggioni, Aldo P. ; Marino, Paolo ; Hernandez-Bernal, Francisco ; Tognoni, Gianni ; Labarta, Violeta ; Gramenzi, Silvana ; Bianchi, Federico ; Sarcina, Giuseppe ; Cremonesi, Giovanni ; Nicolosi, Gian Luigi ; Geraci, Enrico. / Beneficial effects of angiotensin-converting enzyme inhibitor and nitrate association on left ventricular remodeling in patients with large acute myocardial infarction : the Delapril Remodeling after Acute Myocardial Infarction (DRAMI) trial. In: American Heart Journal. 2003 ; Vol. 146, No. 1. pp. 133.
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abstract = "BACKGROUND: In the large-scale trial, Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-3 (GISSI-3), patients receiving the combination of lisinopril and glyceryl trinitrate benefited most from experimental therapy. Therefore, a multicenter, randomized, double-blind study, Delapril Remodeling After Acute Myocardial Infarction (DRAMI), was designed to assess (1) the possible additive beneficial effect on left ventricular remodeling of nitrates when combined with an angiotensin-converting enzyme inhibitor (ACEI), and (2) the tolerability of a new ACEI, delapril, in respect to lisinopril in patients with large myocardial infarction (MI). METHODS: A total of 177 patients were randomized to receive delapril plus isosorbide-5-mononitrate (IS5MN) placebo, delapril plus IS5MN, lisinopril plus IS5MN placebo, or lisinopril plus IS5MN starting within the first 36 hours after the onset of symptoms and continuing for 3 months. RESULTS: More than 80{\%} of the patients showed extensive ST-segment changes and 36.7{\%} had signs or symptoms of heart failure during the first 36 hours. Over 3 months, IS5MN reduced, by 76{\%}, the increase in LVEDV (17.4 +/- 5.0 mL placebo vs 4.2 +/- 4.4 mL IS5MN, P =.0439), reversed the increase in LVESV (7.5 +/- 3.9 mL placebo vs -5.5 +/- 2.9 mL IS5MN, P =.0052), and increased the recovery of LVEF (1.9{\%} +/- 1.3{\%} placebo vs 6.7{\%} +/- 1.2{\%} IS5MN, P =.0119). Overall, 3-month mortality was 10.2{\%}; the most frequent clinical events were new episodes of severe heart failure (18.1{\%}), persistent hypotension (10.7{\%}), and post-MI angina (18.1{\%}), with no differences between treatment groups. CONCLUSIONS: Administration for 3 months of IS5MN combined with an ACEI, both started within 36 hours from the onset of symptoms, was safe and effective in reducing LV dilation and dysfunction after MI. The 2 ACEIs, delapril and lisinopril, appeared to be equally well tolerated.",
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T1 - Beneficial effects of angiotensin-converting enzyme inhibitor and nitrate association on left ventricular remodeling in patients with large acute myocardial infarction

T2 - the Delapril Remodeling after Acute Myocardial Infarction (DRAMI) trial.

AU - Latini, Roberto

AU - Staszewsky, Lidia

AU - Maggioni, Aldo P.

AU - Marino, Paolo

AU - Hernandez-Bernal, Francisco

AU - Tognoni, Gianni

AU - Labarta, Violeta

AU - Gramenzi, Silvana

AU - Bianchi, Federico

AU - Sarcina, Giuseppe

AU - Cremonesi, Giovanni

AU - Nicolosi, Gian Luigi

AU - Geraci, Enrico

PY - 2003/7

Y1 - 2003/7

N2 - BACKGROUND: In the large-scale trial, Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-3 (GISSI-3), patients receiving the combination of lisinopril and glyceryl trinitrate benefited most from experimental therapy. Therefore, a multicenter, randomized, double-blind study, Delapril Remodeling After Acute Myocardial Infarction (DRAMI), was designed to assess (1) the possible additive beneficial effect on left ventricular remodeling of nitrates when combined with an angiotensin-converting enzyme inhibitor (ACEI), and (2) the tolerability of a new ACEI, delapril, in respect to lisinopril in patients with large myocardial infarction (MI). METHODS: A total of 177 patients were randomized to receive delapril plus isosorbide-5-mononitrate (IS5MN) placebo, delapril plus IS5MN, lisinopril plus IS5MN placebo, or lisinopril plus IS5MN starting within the first 36 hours after the onset of symptoms and continuing for 3 months. RESULTS: More than 80% of the patients showed extensive ST-segment changes and 36.7% had signs or symptoms of heart failure during the first 36 hours. Over 3 months, IS5MN reduced, by 76%, the increase in LVEDV (17.4 +/- 5.0 mL placebo vs 4.2 +/- 4.4 mL IS5MN, P =.0439), reversed the increase in LVESV (7.5 +/- 3.9 mL placebo vs -5.5 +/- 2.9 mL IS5MN, P =.0052), and increased the recovery of LVEF (1.9% +/- 1.3% placebo vs 6.7% +/- 1.2% IS5MN, P =.0119). Overall, 3-month mortality was 10.2%; the most frequent clinical events were new episodes of severe heart failure (18.1%), persistent hypotension (10.7%), and post-MI angina (18.1%), with no differences between treatment groups. CONCLUSIONS: Administration for 3 months of IS5MN combined with an ACEI, both started within 36 hours from the onset of symptoms, was safe and effective in reducing LV dilation and dysfunction after MI. The 2 ACEIs, delapril and lisinopril, appeared to be equally well tolerated.

AB - BACKGROUND: In the large-scale trial, Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-3 (GISSI-3), patients receiving the combination of lisinopril and glyceryl trinitrate benefited most from experimental therapy. Therefore, a multicenter, randomized, double-blind study, Delapril Remodeling After Acute Myocardial Infarction (DRAMI), was designed to assess (1) the possible additive beneficial effect on left ventricular remodeling of nitrates when combined with an angiotensin-converting enzyme inhibitor (ACEI), and (2) the tolerability of a new ACEI, delapril, in respect to lisinopril in patients with large myocardial infarction (MI). METHODS: A total of 177 patients were randomized to receive delapril plus isosorbide-5-mononitrate (IS5MN) placebo, delapril plus IS5MN, lisinopril plus IS5MN placebo, or lisinopril plus IS5MN starting within the first 36 hours after the onset of symptoms and continuing for 3 months. RESULTS: More than 80% of the patients showed extensive ST-segment changes and 36.7% had signs or symptoms of heart failure during the first 36 hours. Over 3 months, IS5MN reduced, by 76%, the increase in LVEDV (17.4 +/- 5.0 mL placebo vs 4.2 +/- 4.4 mL IS5MN, P =.0439), reversed the increase in LVESV (7.5 +/- 3.9 mL placebo vs -5.5 +/- 2.9 mL IS5MN, P =.0052), and increased the recovery of LVEF (1.9% +/- 1.3% placebo vs 6.7% +/- 1.2% IS5MN, P =.0119). Overall, 3-month mortality was 10.2%; the most frequent clinical events were new episodes of severe heart failure (18.1%), persistent hypotension (10.7%), and post-MI angina (18.1%), with no differences between treatment groups. CONCLUSIONS: Administration for 3 months of IS5MN combined with an ACEI, both started within 36 hours from the onset of symptoms, was safe and effective in reducing LV dilation and dysfunction after MI. The 2 ACEIs, delapril and lisinopril, appeared to be equally well tolerated.

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